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[Editorial] Looking beyond the Decade of Vaccines

Sa, 17/11/2018 - 00:00
When in 2010 the global health community declared the so-called Decade of Vaccines, it marked a path towards an ambitious vision for 2020: a world in which all individuals and communities enjoy lives free from vaccine-preventable diseases. The Global Vaccine Action Plan (GVAP) 2011–2020, a multisectoral effort led by WHO, set highly challenging targets, progress towards which would be assessed by the Strategic Advisory Group of Experts on Immunisation (SAGE). With the publication of the penultimate assessment report of the GVAP, and as the turn of the decade looms, it is time to take stock and look beyond 2020.

[Editorial] The future of Trump's global health agenda

Sa, 17/11/2018 - 00:00
Last week's US midterm election was a partial rebuke to President Donald Trump. But although Trump's legislative agenda has largely come to an end, his ability to affect global health through non-legislative means remains vast. His record to date is not encouraging. The USA spends more than US$35 billion on foreign aid each year, and there are numerous ways that Trump can manipulate the appropriated funding to suit his whims: defer or ignore allocated funds until the end of the fiscal year or transfer funds from one programme to another, such as when Trump transferred $10 million from disaster relief to Immigration and Customs Enforcement this year.

[Editorial] Time to address nutritional security

Sa, 17/11/2018 - 00:00
Last week, the Global Panel of Agriculture and Food Systems for Nutrition (GLOPAN) published a policy brief: Preventing nutrient loss and waste across the food system: policy actions for high quality diets. The brief argues that loss and waste of high-nutrient foods from our global food systems is a huge problem, which, if addressed, could help tackle all forms of malnutrition and improve poor-quality diets that lead to ill health.

[Comment] Where are the women in academic cardiology?

Sa, 17/11/2018 - 00:00
Women are a minority of cardiologists. Despite gender parity among medical students and internal medicine residents in the USA and in Europe, only 21% of cardiology fellows in the USA and 16·8% in the UK are women.1,2 This drop-off has been labelled the “residency to fellowship cliff” by Pamela Douglas, Chair of the American College of Cardiology (ACC) Taskforce on Diversity, and former ACC president.3 These proportions are comparable to US female trainees in thoracic surgery (21%), neurosurgery (17%), and orthopaedic surgery (15%).

[Comment] Offline: Part of the human experience

Sa, 17/11/2018 - 00:00
Over the past decade, 800 new psychoactive substances have entered the illicit drug market. Between 2011 and 2015, drug-related deaths increased by 145%. One in five prisoners are in custody for drug-related offences. 3940 people have been executed for such offences during the past 10 years alone. In 2016, 275 million people aged 15–64 years used drugs, a 31% increase since 2011. Only 1% of those who inject drugs live in countries with needle-exchange programmes. In the USA, 72 600 people died from drug overdoses in 2017, a three-fold increase since 2002.

[World Report] Fighting a polio outbreak in Papua New Guinea

Sa, 17/11/2018 - 00:00
The vaccine-derived polio outbreak in Papua New Guinea was a disaster many experts saw coming as a consequence of the crumbling health system. Jo Chandler reports from Port Moresby.

[World Report] So-called babies without arms cases cause concern in France

Sa, 17/11/2018 - 00:00
An official enquiry will investigate the causality between this deformity and exposure to external factors. Sharmila Devi reports.

[World Report] Turkey's proposed bill could challenge doctors' livelihoods

Sa, 17/11/2018 - 00:00
Since a failed coup, the Turkish Government has been carrying out what seems like a campaign against the Turkish Medical Association. This bill would be the latest blow. Sharmila Devi reports.

[Perspectives] In the front line

Sa, 17/11/2018 - 00:00
The centenary of the end of World War 1 has reminded us of its terrible death toll. But all the fatalities from Verdun, the Somme, Passchendaele, and the rest were exceeded by those in a single event just as hostilities ceased: the global influenza pandemic of 1918. Spanish Flu: Nursing During History's Deadliest Pandemic, an exhibition at the Florence Nightingale Museum, beneath St Thomas' Hospital in London, UK, is a small but timely reminder of the most catastrophic disease outbreak of modern times.

[Perspectives] In search of motherhood

Sa, 17/11/2018 - 00:00
A desire for motherhood is the focus of Stories, a new play written and directed by Nina Raine at the National Theatre, London, UK. It's a subject that's been represented before on stage, notably by Spanish playwright Federico García Lorca in his masterpiece Yerma, in which the lead character's desperate need to become a mother sends her into a spiral of self-destruction. In Stories, however, Raine takes a more comedic approach.

[Perspectives] Susan Buchbinder: driving HIV prevention efforts worldwide

Sa, 17/11/2018 - 00:00
Susan Buchbinder's drive to fight the HIV epidemic started, as with many of her colleagues, when she was treating patients during the 1980s. “While some doctors and nurses turned their backs and refused to treat patients with HIV/AIDS in those early days, many of us fought hard to do all we could, when we had so few tools available to us. That same group of colleagues continues to work on HIV to this day, and are some of the leaders in developing new prevention and treatment tools”, says Buchbinder, now Clinical Professor of Medicine, Epidemiology, and Biostatistics at the University of California, San Francisco (UCSF), CA, USA.

[Perspectives] Reimagining addiction

Sa, 17/11/2018 - 00:00
The Narcotic Farm was established in 1935 in Lexington, KT, USA, by the US Department of Public Health with two aims. First, it was to create a new way of dealing with addiction as an issue of health rather than criminal justice, by offering treatment and rehabilitation instead of punishment and retribution. Second, it aimed to bring together researchers to study addiction in its Addiction Research Center, and to find a cure. “Narco”, as it was commonly known, was a noble idea, designed to support men and women convicted of drug-related offences alongside those who made a voluntary decision to commit to treatment.

[Obituary] Elizabeth Fee

Sa, 17/11/2018 - 00:00
Influential historian of science, medicine, and public health. Born Dec 11, 1946, in Belfast, UK, she died from complications of amyotrophic lateral sclerosis in Bethesda, MD, USA, on Oct 17, 2018, aged 72 years.

[Correspondence] Risk thresholds for alcohol consumption

Sa, 17/11/2018 - 00:00
We read the paper by Angela M Wood and colleagues1 (April 14, p 1513) on risk thresholds for alcohol consumption with great interest. However, we were surprised by their decision to eliminate non-drinkers from their analysis. We do not consider their justification for doing so scientifically valid; they eliminated non-drinkers because of notable differences in baseline characteristics compared with current drinkers.

[Correspondence] Risk thresholds for alcohol consumption

Sa, 17/11/2018 - 00:00
Over the past decades, observational studies have taught us a lot about the relation between alcohol consumption and health. The effects of alcohol on health are now understood to differ depending on the amount of alcohol consumed, the age and gender of the consumer,1 and the various endpoints studied. Most studies find that individuals who abstain entirely from alcohol consumption might be worse off than moderate drinkers,1 and virtually none have reported a beneficial effect of abstention on mortality compared with moderate consumption.

[Correspondence] Risk thresholds for alcohol consumption

Sa, 17/11/2018 - 00:00
Angela M Wood and colleagues1 conclude that all-cause mortality is higher in people consuming 100–200 g alcohol per week than in people consuming 0–100 g alcohol per week. However, data on p38 of the appendix suggest that this is only true for people who consume alcohol twice a week or less. For those who consume alcohol more often, consuming up to 200 g per week does not seem to increase mortality, as long as the individual does not engage in binge drinking behaviour. People consuming alcohol more than 2 days a week had lower mortalities than those consuming alcohol 2 days a week or less, if they consumed the same amount of alcohol.

[Correspondence] Risk thresholds for alcohol consumption – Authors' reply

Sa, 17/11/2018 - 00:00
To define alcohol consumption thresholds associated with lowest risk for all-cause mortality and cardiovascular disease subtypes, we analysed individual-participant data from 599 912 current drinkers without previous cardiovascular disease.1 Among current drinkers, the threshold for lowest risk of all-cause mortality was about 100 g per week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk-based thresholds below which lower alcohol consumption stopped being associated with lower disease risk.

[Correspondence] Perspective of Middle Eastern war-displaced medical students

Sa, 17/11/2018 - 00:00
Having the potential to become successful is not enough when living in a conflict area such as the Middle East, where wars destroy future plans, making survival the primary goal. Wars have caused damage in all aspects, forcing millions of people to leave their countries and start new lives. As students originating from this area, we describe our experience of studying medicine in foreign countries.

[Correspondence] Memory recall of traumatic events in refugees

Sa, 17/11/2018 - 00:00
The migratory movement from sub-Saharan Africa, east Africa, and the Middle East towards North America and western Europe is ongoing, implicating more and more health-care professionals.1 People who are migrating are more susceptible to physical or psychological disabilities, therefore seek increased assistance from health-care professionals, especially because of physical or psychological disabilities, or both.2–4 These traumas and much of the susceptibility to their development might be sustained by the administrative and political process of obtaining asylum in itself.

[Department of Error] Department of Error

Sa, 17/11/2018 - 00:00
Kappos L, Bar-Or A, Cree BAC, et al. Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomised, phase 3 study. Lancet 2018; 391: 1263–73—The appendix of this Article (published Online First on March 22, 2018) has been corrected as of Nov 15, 2018.